Ars chirurgica a compendium of the theory and practice of chirurgery in seven books ... shewing the names, causes, signs, differences, prognosticks, and various intentions of curing all kinds of chirurgick diseases ... : to which is added Pharmacopoeia chirurgica, or, The medical store, Latin and English ... / by William Salmon ...

VI. Tumors arising from MELANCHOLY.

CHAP. XXXIV. Of a POLYPUS.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Multipes; ex 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 multus, & 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 pes; in Latin, Polypus, Sarcoma, Noli me tan∣gere; in English, a Polypus, or Cancerous Tumor.

II. The Kinds. It is twofold: 1. That in the Nostrils, which is properly called Polypus. 2. That which happens in other Parts, which they generally call Sar∣coma, and Noli me tangere.

I. Of POLYPUS.

III. Definition. Polypus is a pre∣ternatural Tumor, being a fleshy Excrescence, long, and hanging in the Nostril, hindering respira∣tion, and threatning suffoca∣tion in time of sleep.

IV. Celsus, lib. 6. cap. 8. Est Caruncula, inquit, modò alba, modò subrubra, quae Narium Ossi inhaeret; & modo ad Labra pen∣dens Narem implet, mod•• retrò per id foramen, quo Spiritus à Naribus ad Fauces descendit, adeò increscit, ut post Ʋvam conspici possit. — Feréque mollis est, rarò dura; eaque magis Spiritum impedit, & Nares dilatat, quae ferè 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 est, itaque at∣tingi non debet. It is a Caruncle (says he) sometimes white, some∣times reddish, which sticks close to the Bone of the Nostrils, and sometimes hangs down to to the Lips, filling the Nostril; sometimes it grows upwards, thro' the same passage of the Nostril by which the Breath is drawn inwards, increasing so much, as that it may be seen beyond the Uvula. — It is mostly soft, seldom hard; and by so much the more as it fills the Nostril, it hinders the Breathing; which is almost of a Cancerous nature, and there∣fore not to be touched.

V. The Causes. It is caused of a thick and viscous Humor, or flegmatick matter mixed with the Blood, falling down from the Brain; which not being acrid, seldom comes to exulceration.

VI. Sometimes it arises from a Melancholy Humor mixed with an acrid Salt; and then it is

painful, and is apt to degenerate into Cancer.

VII. The Signs. It is known by sight, and the Description afore∣given by Celsus; being purely a piece of Flesh growing in the Nostril, and hanging down.

VIII. The Prognosticks. If it soft, white, and void of pain, it is is easily cured: but if it is red∣dish, with more difficulty.

IX. If it is of a brown, or livid colour, it is scarcely curable; more especially if it be livid and stinking, being of a Cancerous nature.

X. The more deeply it is rooted, the more dangerous it is; because nearer the Brain, and the more difficult to have Medicines ap∣plied to it: but the more external and visible, the less difficult of cure.

XI. If it proceeds from an acrid Salt, and melancholy Hu∣mor, it is apt to degenerate into Cancer; and this is that which Celsus thinks not fit to be touched, lest it becomes a Can∣cer, and overspreads the whole Face.

XII. But that which has no∣thing of a Cancerous humor in it, tho' inveterate, yet it admits of Cure by Chirurgery, viz. with the Knife, and drying Medicines.

XIII. The Cure. The Body is to be universally purged, as is usual in all Diseases of the Head, with such things as have a general tendency; of which we need say no more in this place.

XIV. The Humor may be de∣rived by application of Vesicato∣ries, Seton, Fontanels, &c. and the Head strengthned with pro∣per Cataplasms, Cerates, and Emplasters; which may be applied to the Forehead, or fore-part of the Head, to inter∣cept the Fluxion.

XV. The piece of Flesh then hanging in the Nostrils, is to be eradicated and taken away; which is to be done, either with the Knife, or other proper In∣strument, or with Medicines.

XVI. If the Polypus has a slender root, it is to be taken away either with a Thread, or the Knife: if it can be easily come at, let it be cut off by the roots, with an Incision-knife; some nip them off with a pair of Pincers.

XVII. After extirpation, the Wound is to be healed with things drying and styptick: and the outward parts are to be de∣fended with things strengthning and astringent applied to the Forehead.

XVIII. ℞ Pomgranate-peels, Balaustians, A. ʒi. Cadmia fossi∣lis ʒii. Crocus Martis, crude Antimony, A.ʒss. Litharge, Load∣stone, Mastich, Myrrh, A.ʒi. make a fine pouder; which apply to the Wound, mixed with Mel Rosarum, &c.

XIX. If this does nothing, for that some part of the roots of it remain, you must then come to Exedents. ℞ Alum burnt, Ba∣laustians, fine Bole, ana; make them into a pouder.

XX. Or this, which is stronger. ℞ Vitriol ʒiv. Alum, Galls, Pom∣granate-peels, A. ʒii. red Myrrh, Birthwort-root burnt, A.ʒi. make them into a pouder.

XXI. This is yet stronger.

℞ Vitriol ℥iv. Alum, Verdigrise, A.℥ss. Vinegar ℥vi. mix, and cal∣cine in a luted Retort: mix this or the former with Mel Rosarum, and apply them.

XXII. This is said to be most effectual. ℞ Arsenick red and yellow, Alum, Galls, A. ℥ss. Galls, A. ℥ss. make them into a fine pouder. And some have been perfectly cured with the Pulvis Cathereticus Clossaei, as also the Pulvis Causticus Bar∣betti; which last see in Our Doron Med. lib. 2. cap. 21. sect. 28.

XXIII. Others have had them eradicated with the Liquor Mer∣curii sublimati, (in Our Pharm. Lond. lib. 4. cap. 11. sect. 24.) but it may be fit to make it with double or treble quantity of Mercury: this is only Corrosive-sublimate dissolved in fair Wa∣ter, about ʒi. to a pint.

XXIV. Aquapendens and Sen∣nertus commend a pair of For∣ceps, with which they are to be laid hold of, pull'd forth, and then cut off; after which, some of the former astringent and drying Medicines are to be applied; or else the afore de∣scribed Escaroticks, to eat in, and take it away by the roots.

XXV. Or these following. Butter of Antimony, Spirit and Oil of Vitriol, or Sulphur, Lapis Medicamentosus Crollii, Oleum Mercurii, Menstruum duplica∣tum, &c. which last see in Out Seplasium, lib. 2. cap. 6. sect. 22.

XXVI. But in the use of these things, you ought to defend the Nose with some cooling Ointment; and they are to be conveyed to the Part in Pipes fitted for this purpose.

XXVII. If you use the actual Cautery, you must beware of the adjacent Parts and apply it to the Part thro' a Pipe.

XXVIII. If it is Cancerous, viz. livid, or black and blew, or pain∣ful, it is not then to be touched; for if you meddle with it, it soon degenerates into Cancer, and becomes incurable.

XXIX. In this case, ℞ Ung. è Plumbo, juice of Nightshade, Rose-water, A. ℥i. grind them a long time in a leaden Mortar, till the Mixture is sufficiently blew, and anoint therewith.

XXX. Or, ℞ Two yolks of new laid Eggs, grind them in a leaden Mortar even to blackness: to which add, Aethiops Mineralis. Oil of Ben, A. ʒii Camphir ʒss. mix, and anoint therewith. Or, ℞ Ung. è Plumbo ℥i. Aethiops Mineralis ʒii. Extract of Opium ʒi. mix them in a leaden Mor∣tar as aforesaid, with which anoint.

II. SARCOMA, or Noli me tangere.

XXXI. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Carnositas, Carnis praeter naturam incremen∣tum, is that other sort of Polypus, of which Celsus in the place afore cited) speaks in these words; Illud aliud genus ferd quidem ferro curatur; interdum tamen inarescit, si addita in Na∣rem per Linamentum aut Peni∣cillum ea compositio est, quae habet Minii Sinopici, Chalcitidis, Cal∣cis, Sandarachae, singulorum p. i. Atramenti Sutorii p.ii. There is

another kind, which may indeed be nearly cured with the Knife: yet sometimes it is healed by drying Medicines, being applied to the Nostril with Lint, or a Pencil; such as this, ℞ Fine Bole, Chalcitis, Lime, red Arsenick, ana p. i. common Vitriol p. ii. make all into a fine pouder.

XXXII. Sarcoma to me seems to be only a species of Polypus, but happening in a different place: for whereas the Polypus specially so called, happens only within the Nostril; this other spe∣cies happens in other parts, as about the Nose, Lips, Chin, Cheeks, near the Eyes, Breasts, Arms, Thighs, Legs, Shins, Ancles, &c.

XXXIII. Sennertus, lib. 1. part. 3. sect. 4. cap. 3. Caeterùm differt à Polypo, Sarcoma, in∣quit, ut genus à specie, figurâ item, & magnitudine: nam Sar∣coma rudis quaedam Carnis massa est, certâ figura carens, & saepe in magnam molem excrescit: etiam carne à Polypo distat, quo∣niam durior est, & dolorem infert, ac nigrescit aut livescit, ac Venas circumquaque crasso Sanguine tur∣gidas habet, ac plerumque intus prope viciniam Narium, & Pala∣tum nascitur. Viz. Moreover, (says he) Sarcoma differs from Polypus, as genus from species; and that both in figure and magnitude: for Sarcoma is a certain rude mass of flesh, of no regular form, and often∣times grows forth into a great lump: it differs also from Poly∣pus in the substance of the Flesh, because it is harder, and with∣all painful; and grows either blackish or livid, having turgid Veins round about it, filled with a gross or thick Blood: it is also produced inwardly, near to the Palate, or the ad∣jacent parts of the Nostrils.

XXXIV. From what has been said, it appears, that a Sar∣coma is of two kinds, viz. be∣nign and malign: the latter of which is denominated again, according to the place it af∣flicts: for if it possesses any part of the Face, as Nose, Lips, Cheeks, Eyes, Chin, it is called Noli me tangere: but if it pos∣sesses other lower parts, as the Breast, Arm, Thigh, Leg, Shins, Ancles, &c. it is called Lupus, the Wolf.

XXXV. The Causes. The Be∣nign arises from a thick Blood mixed with a Pituitous Humor, tough and viscous, extravasated; and filling some particular Glan∣dule of the Cutis, which by a daily aggravation of fresh mat∣ter increases into this form and substance.

XXXVI. The Malign arises from a thick Blood mixed with Atra-bilis, or a Melancholy Hu∣mor, acrid and corroding; which being also extravasated, and separated from the nourishment of the Part, grows into a malign Sarcoma.

XXXVII. Signs. Noli me tange∣re, is a Tumor, or Ʋlcer arising about the Nose, Lips, Cheeks, Mouth, or Chin; being for a long time, as a Year or more, no bigger than a Pustule, and is as it were a very small and inconsiderable Push.

XXXVIII. Its growth and in∣crease is very slow at the beginning,

afterwards is it becomes a little larger Tumor; and (possibly by ill handling) a corrosive Ulcer, having a resemblance with, and being very like to an exulce∣rated Cancer.

XXXIX. In other parts of the Body, where it is called Lupus, its beginning is like the former; but when it becomes exulcera∣ted, if it is in a very fleshy Part, it corrodes or eats much more; and as I suppose, from that vehement corrosion, it was cal∣led The Wolf.

XL. The Prognosticks. The Be∣nign is more easy of cure, the Malign more difficult; and if it be truly Cancerous, not to be medled withal, unless it is to∣tally taken away by the roots.

XLI. Noli me tangere, which is benign, (being a small, round, acuminated Tubercle, without much pain, unless it be touched or rubbed,) is always exasperated by sharp Medicines; and Corro∣sives are apt to make it dege∣rate into a Phagedenick Ulcer.

XLII. The Malign, if they be ulcerated, yet corrode but slowly; for saith Rogerius, in c. 5. Cancer plus corrodit uno die, quam Noli me tangere in uno mense: Noli me tangere does not corrode or eat so much in a month, as a Cancer does in day.

XLIII. And being once ulcera∣ted, if it is vehemently exaspe∣rated, or enraged, it immediately becomes a true Cancer.

XLIV. The Cure. The Benign (which is not deeply rooted) may as Celsus says, be almost cured with the Knife alone; drying Medicaments being afterwards applied to it, to heal it.

XLV. But if it is Malign, it is scarcely at all to be touched, but only with Palliatives; as Ʋng. è Plumbo, mixed with Aethiops Minerale and Opium; Ceruse, Saccharum Saturni, Sal Jovis, (which is a Specifick in this case) Mercurius dulcis ground small with a few drops of Oil of Tartar, Emplastrum Mercu∣riale, a plate of Lead besmeared with Quicksilver, Lixivium of Quicklime, &c.

XLVI. If you determin the Extirpation thereof by Chirurgery, the Body ought to be beforehand sufficiently evacuated, by such things as purge Melancholy: and some∣times a little gentle Salivation may be profitable, if it is in any of the lower or depending parts of the Body.

XLVII. Then you may come to the Extirpation; which is best done with the Actual Cautery: but here you must be sure to burn to the roots of it; or else to apply after the Actual Cau∣tery, Escaroticks, which may consume the very roots thereof.

XLVIII. But by reason the Actual Cautery is so dreadful, that few will admit thereof, we will shew you the Method of doing it with the Potential Cautery; which is thus. First, draw a Line with Ink round about the Tumor, as far as you intend to burn it. This done,

XLIX. Secondly, begin with the Caustick-stone, made sharp-pointed, which press upon the middle of the Tubercle, burning deep into it: and to quicken the Work, touch it with Butter of Antimony,

or Oil of Vitriol upon a Stick, and then again with the Cau∣stick-stone interchangebly, till you have consumed the Tuber∣cles, and the Parts marked within the Line.

L. Thirdly, whilst this is thus doing, dry up the Salts, which are dissolved in the humidities of the Tumor, with armed Probes; af∣ter which wash out the Salts of the Caustick with warm White-wine; and then divide the Escar, and wash it again with Milk, or a soft Lime-water, till the Tumor or Part is freed from pain.

LI. Fourthly, then dress it with Ung. Basilicon cum Oleo Rosa∣rum upon a Pledget, and apply over all Emplastrum è Bolo: by which things the Escar will be separated, and a deep round Ulcer left.

LII. Fifthly, then digest with Ung. Basilicon nigrum, mixed with red Precipicate; after which you may incarnate and cicatrize with Ʋnguentum Tutiae, or some other like Medicine.

LIII. Lastly, you must be sure to eat deep enough at first, to consume the very root of the Tumor; otherwise after the coming off of the Escar it will arise again, and put you to new trouble; whereas being once effectually done, it returns no more.

LIV. Wiseman says he saw one on the outside of a Man's Arm, a little above the Elbow; which was a small Tubercle, as big as a Hazle-nut, of a blewish colour, and looked as if it had been a Varix; without inflam∣mation, hardness, or change of colour in the Parts adjacent: he covered it with a Cup made of light wood, with straps fastned to it to tye it on, to defend it from the pressure of his Sleeve. And such another he saw on the Arm of a Woman, of 40 years old; it was on the outside of the Arm, and of a blew colour.

LV. And such a like one I once saw on the inside of the left Arm of a Man, a little above the bending of the Elbow; and an∣other like one, on the Leg of ano∣ther Man of about 50 years of age: they were both of them much about the bigness of a small Nutmeg: they shewed them to me, to have my Opi∣nion; but would not admit of any thing in order to have them cured, or removed.

LVI. An Observation from Wise∣man, Lib. 4. Cap. 6. Obs. 10. A poor Woman had a large Tu∣bercle on the right Canthus, also a Polypus in that Nostril: after the separation of the Tubercle, a Fungus thrust forth, which was very vexatious in eradi∣cating, and unsuccessful: then the Polypus was attempted:

LVII. It was taken hold of by a Ducks-bill Forceps, and pulled outwards; then a Needle with a twisted brown thread was passed thro' it, as Fabricius ab Aquapenente advises; and pul∣ling by that and the Forceps together, it was drawn out about the length of two inches; but was attended with a flux of Blood from the Nose, Mouth, and Eye; which was stopt by Syringing up Oxycrate.

LVIII. At the next dressing

of the Ʋlcer in the Canthus, the Fungus was missing, and a great hole found in the Bone of the Nose; upon which it was con∣cluded, that the Fungus which was there, was the root of the Polypus: the Bone was much corrupted, but the External Cure of the Ulcer was hastned, the Exfoliation of the Bone being left to Nature.

LIX. A certain Noble Woman had all the right side of her Face over∣spread with a Lupus, or a phage∣dene Ʋlcer, which grievously tormen∣ted her for a long time; she sought in vain to the Physicians for help, as well French, Italian, and Spa∣nish, as Germans, together with other Foreign Physicians; but was at length perfectly cured by an ordinary and vulgar Barber-Chirurgeon, by application of Chickens cut into very many thin and broad pieces, which were daily applied to the Part affected, often changing and renewing them: and at length by this only Remedy she was recovered to her pristin health and sound∣ness. Mauritius Cordaeus upon Hippocrates, lib. 1. comment. 7.

LX. I knew also a certain Wo∣man who had a Lupus for a long time on her left Side, below her Breast, which vehemently tor∣mented her; which was by the advice of an old Woman cured in a short time, by the only application of raw Beef to the Part, cut in thin slices, and often renewed.

LXI. But if the Malignity is so great, that none of these things will prevail against the Ʋlcer, or give the Patient any ease; and it is in a Part where Cutting or Burning, or the use of Escaro∣ticks may be safe, there are no other Remedies to be attempted: otherwise the Patients must en∣dure the torment and vileness of the affliction all the days of their lives.

CHAP. XXXV. Of a SCIRRHUS.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Tumor duras; in Latin, Scirrhus; and in Eng∣lish, a Scirrhus, or Hard Tumor.

II. The Definition. It is a preternatural Tumor, of a stoney kind of hardness, without sense or pain, and not yielding to the touch.

III. The Causes. The Antece∣dent Cause is a thick, viscous, clammy, cold Humor, such as is that of Melancholy; or it is caused of Melancholy mixt with Phlegm, Choler, or Blood.

IV. By Melancholy here, Phy∣sicians understand not that thick black Humor, which is called Cho∣ter adust, but that Melancholy which is natural; viz. the thick, and more feculent part of the Blood, or a thick recrement of

the Blood protruded; or a Mat∣ter arising from an indurated Inflammation.

V. By Phlegm also, is not meant that humid and thin Humor, which is the Cause of Oedema; but an Humor thick, viscous, glutinous, and extraordinary dry.

VI. Of the former, or of both these Humors mixed together, and retained in the Part over-long, (the more thin and subtil parts being transpired and gone, and the more gross and thick being left behind) is a Scirrhus gene∣rated.

VII. 'Tis true, thick Humors may flow to a Part, yet they im∣mediately cause not a Scirrhus; but it is by degrees, and after some time, that it becomes such in the Place affected; viz. from the gradual perspiration of the thinner Humor, leaving the thicker Matter behind, which by degrees is impacted in the Part, and grows hard.

VIII. And from hence it is, that tho' a Scirrhus may be an original, and be of its self, yet for the most part it follows upon other Tumors; as a Phlegmon, Erysipelas, Oede∣ma, &c. not sufficiently or rightly cured; where the thin∣ner parts, by heating Medicines are unseasonably or over-much dissipated; or by Repercussives, repressed and driven back, &c.

IX. But Paraeus assents not to all this, but will have it to be caused from an Alimentary Juice, but more thick than is fit for the nourishment of the Flesh; which becomes hardned either in a Phlegmon, or from some other Cause; where the Blood being discussed by the vehement heat, the Matter that remains, is thickned and hardned.

X. The Kinds. It is said to be twofold, according to the Matter that causes it: viz. 1. Perfect or Legitimate, when it proceeds from Melancholy alone. 2. Imperfect or Illegiti∣mate, when it proceeds from Melancholy mixt with other Humors, and has some pain.

XI. A Scirrhus is said also to be, 1. Original, when it is the first Disease; beginning small, and rising slowly and gradually to its bigness. 2. Derivative, when it arises from some other Tumor going before.

XII. And so accordingly they will have it to be Scirrhus Phle∣gmonodes, Oedematodes, Ery∣sipelatodes; to which some have added Scirrhus Cancrosus, when it has an aptness to degenerate into Cancer.

XIII. The Signs. An Original Scirrhus usually begins small, like a Vetch or Pea, and gradually increases to a considerable ma∣gnitude, without shifting or changing of its place.

XIV. It is accompanied with great hardness, is void of pain, and white colour, but sometimes inclining to livid; and being pressed hard with the fingers, it is said to want sense; at leastwise, it is much less sensible than any other part.

XV. The Scirrhus being with∣out sense, it is then said to be absolute and confirmed: now the reason of its want of sense, is, because the influx of the natural

Spirits is hindred by the mat∣ter impacted, and Temper or Tone of the Member it self is so changed, as to become be∣numbed or stupid.

XVI. A Derivative Scirrhus is known from it following some other Tumor; as a Phlegmon, Ery∣sipelas, Oedema, &c. wherein the accidents belonging to those Tumors, suddenly change into that of Scirrhus.

XVII. It is hard and im∣moveable, like the other, and many times of a dark red colour, accompanied with sense, if pressed upon; and is many times full of pain, tho' not continually pain∣ful like a Cancer.

XVIII. The Prognosticks. If it is without pain, and Hair grows upon it, it is altogether incurable; and if livid, it is very dan∣gerous, and often degenerates into Cancer.

XIX. Wiseman says, an ori∣ginal, exquisite, or true Scirrhus, being altogether without sense, admits of no Cure; because the induration of the Part is so great, that it will not receive a free afflux of the Blood into it, but keeps its hardness, in despite of all Applications.

XX. A derivative, illegiti∣mate, or imperfect Scirrhus, which is small and painful, sometimes (tho' very seldom) admits of Cure, but sometimes terminates in a Cancer.

XXI. If it has a mixture of Phlegm with it, it seldom changes the colour of the Skin: and if it is big and hard, and has Hair grows upon it, it is uncurable, but degenerates not into Cancer.

XXII. But tho' it is not altoge∣ther incurable, if at first, fit and proper Remedies be applied; yet notwithstanding it is not easily cured; especially if it is in any of the more noble parts, as Liver or Spleen.

XXIII. And where there is hopes of a Cure, yet it is not ac∣complished, but in a long time; because the thick, hard, and cold matter is not easily mollified and softned; nor can it be done, but by little and little.

XXIV. And when the Cure is to be done, it is either by Resolu∣tion or Discussion, or else by Suppu∣ration: but Suppuration is very rare, and mostly, not without danger; for that it very easily degenerates into Cancer, espe∣cially where the Melancholy Humor partakes of a corrosive, sharp Salt.

XXV. The Cure. It respects, 1. The Procatartick Cause. 2. The Antecedent Cause. 3. The Con∣joined Cause, where the applica∣tion of Topicks comes under consideration.

XXVI. As to the first Indication, the Air ought to be clear, and hot and moist; Food, such as represses the Melancholy, &c. Humor, and breeds good Blood; as Chickens, Pullets, Eggs, Kid, Lamb, Veal, Mutton, young Rabbits, &c. boiled with Borrage, Bugloss, Endive, Succory, Lettice, Pur∣slane, Sorrel, &c. Bread made of Wheat and well baked: things hot and dry are to be avoided.

XXVII. Let their Drink be a middle sort of Ale or Beer, (and not stale,) white Port∣wine, Rhenish-wine and Water,

Whey clarified with Fumitory, Mead, &c.

XXVIII. Let Sleep be mode∣rate, and a constant exercise of Body, to waste the superfluous Humors: let the Mind be kept pleasant and chearful, and the Body soluble; and if it be not so, let it be made so by Clysters: and Courses, Hemorrhoids, if stopt, provoked.

XXIX. The second Indica∣tion, is the Evacuation of the Humor; as with Infusion or De∣coction of Sena, Tinctura Purgans, Syrupus Catharticus, Pilulae Catharticae, Pulvis Cornachini, and other things of like nature; to which add Aurum Vitae, as a specifick.

XXX. This Purging ought to be frequent, and many times re∣iterated; because the Humors abounding are thick, tough, hard to be removed: and some∣times gentle Sweating.

XXXI. Some also make Re∣vulsion to the contrary Part, by Frictions, Cuppings, Scarifica∣tion, &c. or make Derivation, by the Seton, Fontanels, or Issues, &c.

XXXII. The third Indication has respect to the Conjoined Cause; which is to be treated with such Topicks, as the nature of the Disease requires.

XXXIII. And here you are not to use Repercussives or Repellers, for they hurt, by reason the tough, hard and cold Humor is uncapable of being driven back, as hot Hu∣mors are. For this Humor or Matter, as it will not give way to them, so it will rather the more incrassate or thicken them, and as it were impact them, and make them stick faster in the Part.

XXXIV. In this case therefore, you ought to use Emossients, to soften the hardned Matter; and afterwards, when it is softned, Discussives to scatter it.

XXXV. But you ought not to use the strongest Emollients, which do too much mollify, lest you should cause it to degenerate into Cancer: nor the strongest Discussives, which too much discuss or re∣solve, lest you cause it to pass into a stoney hardness.

XXXVI. For which reason, it will be most safe to let the whole course of the Cure be mixt; and that you use not alone any one Medicine, which has in it a power either only to moisten, or only to discuss, but such as mollify and discuss: but not together, but by turns, and one after another.

XXXVII. Yet some Artists mix Emollients with Digestives; for which purpose Galen commends the Fomentation of Vinegar, wherein the Pyrites has been extinguished: the Part being first fomented with the De∣coction of the emollient Herbs; which alternately are often to be repeated: and in this man∣ner, the Scirrhus, which is almost desperate, may be cured.

XXXVIII. Sennertus advises, in a Scirrhus which is but newly begun, to use those Medicaments which are of the milder sort: but in an old or inveterate Scirrhus, or if it is in a Tendon or Ligament, those that are more strong.

XXXIX. Among the milder sort of Emollients are, Oils of sweet Almonds, of Camomil and white Lillies; Butter, Hens, Geese, Ducks, Hogs, Dogs, Foxes, Man's Grease, (which last is a Specifick;) Vipers fat, Marrow of Veal, and of a Hart; Muci∣lages of roots and leaves of Marrows, Marsh-mallows, Line and Foenugreek-seed, Arach, Wax, fat Figs, &c.

XL. Among the stronger Emol∣lients these are numbred; old Oil-olive, Whale-oil, Bears-grease, Bdellium, liquid Storax, Tar, fat Rosins, Turpentine, Balsam Capivii, de Chili, Gi∣lead, Peru and Tolu, Ammonia∣cum, Galbanum, Opoponax, and Sagapenum.

XLI. Among Compounds, Oint∣ment of Marsh-mallows, Empl. Diachylon simple, Treatum, & cum Gummis, Diachylon composi∣tum, and that of Melilot simple, &c.

XLII. Among Discussives, these are commended; Bean-meal, and meals of Lupins, Cicers, and Orobus, flowers of Camomil, Melilot, and of the Elder-tree; leaves of Angelica, Avens, Ale∣xanders, Bawm, Calamint, Ca∣momil, Dill, Elder, Dwarf∣elder, Fetherfew, Fennel, Hore∣hound, Marjoram, Mint, Ori∣ganum, Peniroyal, Rue, Sage, Southernwood, Tansy, Worm∣wood: Seeds of Anise, Cara∣ways, Cumin, and Fennel; roots of Florentine-orrice, and Ele∣campane: Oils of Bays, Nard, and Rue: Cataplasma de Fermento, Resolutivum Foresti, Leven, and Dung of Beasts; roots of wild Cucumbers, Briony, Solomon's-Seal, Orrice, &c.

XLIII. Among Compound, these; Ceratum de Ammoniaco Fo∣resti, Emplastrum de Galbano, or de Mastiche, or Oxycroceum, or this of Barbett: ℞ Gum Ammoniacum, Galbanum, Opopo∣nax, A. ℥i. flowers of Sulphur, red Myrrh, A. ℥ss. Camphir ʒi. Oils of white Lillies, Ducks-grease, A. ʒvi. Wax, q.s. mix, and make an Emplaster.

XLIV. Barbett commends this Cataplasm: ℞ Roots of Altheae ʒiii. Orrice ℥i. leaves of Cole∣worts, Parietary, Mallows, flowers of Camomil, Melilot, A. M.i. Lin∣seed ℥ii. boil them in Water, then beat them well together, and add Horse-dung ℥ii. Hogs-grease, Oil of Camomil, A. ℥iii. roasted or boiled Onions ℥ss. mix, and apply them.

XLV. A Cataplasm also of Briony-roots, Goats-dung, and Ʋrine, mixed together, and ap∣plied; often renewing it for several days, is accounted an excellent thing.

XLVI. But Sennertus says, that if it should prove tedious to use Emollients and Discussives thus alternately, or by turns, that at length they may be all mixed together: for that by this means, the Tumor will be both mollified and discussed, or dis∣sipated together.

XLVII. And for the same purpose, you may apply this: ℞ Fresh Butter, Scammony, Wax, A. q.s. mix, and make a soft Cerate, which renew every other day.

XLVIII. Or this: ℞ Ceratum

de Ammoniaco Foresti ℥jss. Sul∣phur vive, ʒiii. mix them, and apply it; renewing it once every day: or a Cataplasm of green Tobacco leaves.

XLIX. Or this: ℞ Meals of Beans, Fenugreek-seed and Lin∣seed, A. ʒvi. roots of Althea ℥i. Pitch ʒv. Goose-grease q.s. mix, and make an Emplaster.

L. Or this: ℞ Meals of Fe∣nugreek, Linseed, Althea-roots, pouder of Holyoke-roots, A. ℥i. boil them in Milk; then add fresh Butter ℥jss. liquid Storax, Ammo∣niacum, Bdellium dissolved in Vinegar, A. ℥ss. mix, and make a Plaster.

LI. Or this: ℞ Althea-roots, white Lilly-roots, Briony-roots, boiled and well bruised, A. ℥iii. fat Figs boiled ℥ii. Ammo∣niacum, Bdellium (dissolved in Vinegar) A. ℥i. liquid Storax ℥ss. Goose and Hens fat, Veal-marrow, A. ℥iii. Oils of Lillies and Camomil, Wax, A. q.s. mix, and make an Emplaster.

LII. If the Scirrhus is more confirm'd, and fixt among Liga∣ments and Tendons, the Fumes of Wine-vinegar, and Spirit of Wine sprinkled upon the Pyrites, or a red-hot Brick, are of special virtue in resolving these Tu∣mors; afterwards chafing the Part a little, apply the follow∣ing Emplaster.

LIII. ℞ Ammoniacum, Bdel∣lium, Galbanum, Opopanax, Saga∣penum, liquid Storax dissolved in Vinegar, A. ℥i. Litharge of Gold ℥jss. let them boil in Vinegar; then add Bean-meal, Sulphur vive, A. ℥ss. Oil of Lillies, Wax, A. q.s. mix, and make a soft Emplaster or Cerate.

LIV. If by the Ʋse of these Applications it should tend to Suppuration, you must treat it accordingly: but take heed that you be not deceived; for if it should prove no Suppuration, it may degenerate into Cancer.

LV. And if it inclines to Sup∣puration, you must have a care that it be not too much irritated by hot Medicines: and avoid Lancing it, lest it presently turns Cancerous: and Cauteries and Burning are far worse: except the Tumor is in a proper Cystis, and then the name of Scirrhus is improper.

LVI. If being suppurated, it breaks, cleanse it with the Ablu∣tion of Mercurius dulcis in Lime-water; Basilicon mixt with Mercurius dulcis levigated, or white Precipitate: and lay over all Diachylon simplex, or some other Emplaster of like nature.

CHAP. XXXVI. Of a CANCER.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, and 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 by Galen; in Latin, Cancer; and in English, a Cancer, or Hard painful Tu∣mor.

II. The Kinds. 1. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Cancer; whilst it is beginning, growing, or increasing, and not ulcerated. 2. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Car∣cinoma; after it is broken, runs or gleets, by any means whatsoe∣ver; called by some, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Cancer ulceratus; or 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Ʋlcus can∣ceratum: of these we shall treat distinctly or apart; but some I know, will have Carcinoma to be a Cancer not ulcerated.

I. A CANCER not Ʋlcerated.

III. The Definition. Tumor praeternaturalis est, ab atra Bile originem trahens, rotundus, durus, inaequalis, coloris lividi aut sub∣nigri, magnas & eminentes cir∣cumquaque habens Venas, vel Venis circumcirca turgidis, pedes Can∣cri referentibus, dolore, caloré∣que gravis, aspectu teter & hor∣ribilis. A Cancer is a preter∣natural Tumor, taking its origi∣nal from burnt Choler, round, hard, unequal, of a livid or blackish colour; having great and eminent Veins every-ways round about it; or full of tur∣gid Veins, resembling the feet of a Crab, full of pain, and very hot, with a cruel and hor∣rible aspect.

IV. The Causes. Authors say the Procatartick Cause is from ill Diet, Meats of an ill juice, of a thick substance, and a hot qua∣lity; as Garlick, Onions, Leeks, Beans, Pease, Venison, and the like: the immoderate use of strong Wines, as Sack, Malaga, Sherry and Greek Wines; which exceedingly burn the Humors in the mass of Blood; hot Air, perturbations of Mind, strokes, blows and external violence, ill handling.

V. The Antecedent Cause is Atra-bilis, Choler adust or Me∣lancholy: but this they will not have to be natural Melancholy, which Galen, ad Glauc. lib. 2. cap. 10. affirms to be that part of the Blood which represents the Lees of Wine; which is made by the Liver, and is drawn by the Spleen, wherewith it is nourished: for this superfluous natural Melancholy, they will have only to breed a Scirrhus.

VI. They will have it then to be from Atra-bilis, which is either natural Melancholy adust, or yellow Choler adust; which is much more malign than the former; from a strong hot distemperature of the Liver, which burns the natural Melancholy and yellow Choler, and so generates this malign Atra-bilis:

the Spleen also by reason of its discrasy, not drawing to it self the superfluous natural Melancholy; whereby staying so long out of its own pro∣per place, it is inflamed and burned.

VII. Another Antecedent Cause, may be a stopping of the Hemor∣rhoids in Men, whereby they have been usual; and the stoppage of the Courses in Women, before their due time.

VIII. The Conjoined or near Cause, Galen, de Tumor. praeter∣nat. cap. 12. saith, is, from Atra-bilis seating it self in the Flesh; where if it is mild, it makes the Tumor which we call a Cancer; but if it is very sharp, it corrodes the adjacent Flesh, and causes an Ulcer, which is a Cancer ulcerated.

IX. Sennertus, Med. Pract. lib. 5. part. 1. cap. 20. says the conjoined cause of a Cancer is Atra-bilis, hot, dry, sharp, and salt, corrupting and corroding all things, generated and bred from the heat of other Humors; which heat now ceasing, or not being so vigorous, is the reason that it excites not a Fever, as is usual in a Phlegmon or Erysipelas.

X. Wiseman says, he believes not this Adustion of Humors to be the cause; but rather that the Matter of the Humor is in fault, which by some error in Concoction, becomes sharp and corrosive, it may be Arsenical, as appears by the Sloughs which are some∣times made in a Night.

XI. This Humor being sharp and corrosive of it self, is apt to convert whatever comes to it of Blood, into the same acrimony with it self: which is easily done, by mixing such an acrimonious Ferment with a Liquor that abounds with acid Salts, as the Blood of such persons usually does.

XII. And being such, it in∣creases apace while the Skin is yet whole; but much more, when upon breach of the Skin, the accession of Air adds to the vigour of the Ferment; upon which it grows fierce or en∣raged, and so thrusts it self forth into a Fungus, Tuber∣cles, &c.

XIII. But it seems to me, that the Antecedent Cause is more truly a discrasy of the Blood and Lym∣pha, being filled with an acrimo∣nious Salt, and a malign Sul∣phur; which they endeavouring to purge themselves from, let it fall thro' the mouths of some of the Capillary Arteries; and so protrudes it into the fleshy substance, where the Part is weak, and made apt to receive the same.

XIV. And the Conjoined Cause is, those extravasated Recre∣ments of the Blood and Lympha, which (being protruded as afore∣said in a Part accidentally weak, or naturally apt to receive a flux of Humors) thro' the depravity of the same, and a vitious Ferment therein; are farther changed into a malign and poisonous Matter, of a vehemently dele∣terious nature, consisting of a stinking Arsenical Sulphur, and a Catheretick or highly corro∣sive Salt, extreamly subtil and penetrating.

XV. That this is true, the Death of Mr. Smith, one of the Chirurgeons of St. Thomas Ho∣spital in Southwark, gives wit∣ness. For at the cutting off of a large Cancerated Breast, he had (after the Breast was off) a curiosity to taste the juice or matter contained in one of the little Cystis's or Glands of the same, which he did by touching it with one of his Fingers, and then tasting it from the same, with his Tongue.

XVI. He protested that it im∣mediately, like a Gass, pierced or went thro' the whole sub∣stance of his Tongue, and down his Throat, not less sharp or biting than Oil of Vitriol, Spirit of Nitre, or some vehement cathere∣tick or caustick Salt: and altho' he presently spit out, and wash'd his Mouth with Water, and that oftentimes, and also with Wine, and drank pre∣sently very freely of Wine after it; yet could he not get rid of the Taste thereof, but it continued with him, and brought him (who was a very strong Man) into a Consumption, or wasting and pining condition, with several other ill Symptoms; and in a few Months after kil∣led him, the Taste thereof never going off from his Tongue, to his dying hour: and the tasting of the Juice or Matter of that cancerated Breast, he declared upon his death-bed, and near the last moments of his life, to be the true cause of his languishing condition and death.

XVII. The Places. This Dis∣ease is apt to seize upon any fleshy part; as the Cheeks and Jaws, Sides, Back, brawney parts of the Arms, Thighs and Legs, Hands and Feet; the Liver, Spleen, and Womb; but chiefly such parts as are Glandulous; and many times it begins in the Glandule of a Part; and most often affects Womens Breasts, by reason of their loosness, great humidities, and strong ferment they contain.

XVIII. The Signs. A Cancer in its beginning is very difficult to be known, not exceeding a Pea or Bean in bigness, and increasing slowly to the bigness of a Melon or Pompion sometimes, (yet some∣times it suddenly grows great;) and discovers it self by its grievous Symptoms. Galen, meth. Med. lib. 14. cap. 9.

XIX. It is hard in substance, full of pain, hot, and of a livid, or blackish colour: roundish, but with some inequality, and full of turgid Veins: the whole resists the touch, and as it in∣creases in magnitude, increases in malignity.

XX. The Hardness is from the thickness of the Humor; the Pain is from the conjoined Cause, being sharp and corrosive; the Heat proceeds from the extremity of pain; the Livid or Blackish Colour, from the malignity and poison, which even discolours the purest Me∣tals; its Roundness, from the thickness of the matter, which cannot spread abroad; its In∣equality, from the ferment of the Humor, and because some∣times it is contained in several

little Glands; and its Turgid Veins, like to Crabs Claws, from the Recrements of the Blood filling those Parts; which by reason of matter obstructing, or pressing upon them, hinders its getting forth.

XXI. It is known in part by the place, (tho' it may breed in almost all parts of the Body,) as in the Lips, because glandulous and loose: so also in the Breasts, for the same reason; and in the Womb, from the retention of the Courses.

XXII. Aegineta, lib. 6. cap. 45. says, a Cancer happens to sundry places, but chiefly to the Womb and Breasts of Women: and Galen says, Cancerous Tumors are chiefly in the Breasts of Women, which have not their Purgation according to Nature. Gal. ad Glauc. lib. 2. cap. 10. and the reason seems to be from the consent of Parts: for that the Mammariae Veins meet with the Ʋterinae, under the Musculi recti of the Belly; by which way there is a translation of the matter from the Womb to the Dugs.

XXIII. Sennertus says, that with the Pain there is always a Pulsation attending it, together with a Heat more than ordinary.

XXIV. Where the Pains are very sharp, as if one were struck with a Dart; the Matter there is very corrosive, and will cer∣tainly in a little time break forth in a Gleet, or some dan∣gerous stinking Ulcer.

XXV. If the Cancer is ulcerated, from the breaking of some of the Tubercles lying under the Skin, whether the matter is much or little, the Ulcer is painful, and very stinking, discharging a stinking Gleet; it also thrusts forth hard and painful Lips, and in time fixes to the Ribs, (where it is in a Breast, or Side) and in its progress becomes of a horrible aspect.

XXVI. These sometimes bleed, either through the eruption of some Vessels, or from the corrosion of the Humor gnawing them asun∣der: and sometimes a Cancer bleeds whilst it is yet whole; for the same reason, the Blood coming forth either at the Nipple, or some small pin-hole.

XXVII. Some ulcerated Can∣cers send forth a Fungus, others consume and eat all the Flesh away after a wonderful manner: both these often bleed, and in large quantities, because the Capillary Vessels are eaten asun∣der; whereby the strength of the Patient is quickly spent, and they soon dye, as consumed away, and exhausted.

XXVIII. The Prognosticks. Barbett says, a Cancer is seldom cured by Medicines, often by Chir∣urgery, but not without danger: all sharp Medicines exulcerate it.

XXIX. A Cancer of the Womb is said to be incurable, except it be very little, or may be taken away by Excision: so also a Cancer of any other internal part; as Mouth, Tongue, Palate, or Anus.

XXX. Galen, ad Glauc. lib. 2. cap. 10. says, that Cancers in the outward parts, may in the beginning be cured; but when they are come to a considerable

bigness, they can only be cured by Extirpation.

XXXI. To a Cancer inveterate, or of long continuance, in a weak person, you cannot safely use Ex∣cision, Actual or Potential Cau∣teries; but a Palliative Cure is only to be prescribed, which in a Cancer not exulcerate, has sometimes preserved Life even to very Old-age.

XXXII. An ulcerated Cancer can never be cicatrized, but as long as it so remains, the Sick will live in continual pain and filthiness, and at last dye mi∣serably; unless it is cured by Excision, Cautery, or Ustion.

XXXIII. If it proceeds from an internal cause in the Blood and Humors, it is generally incurable, by reason of its malign and poi∣sonous Ferment, and corrosive Salts; which yield neither to Purging, Vomiting, Bleeding, Sweating, Salivating, Diet-Drinks, Repulsives, Discus∣sives, Suppuratives, nor any other kind of Medicines, whe∣ther inward or outward.

XXXIV. If it is from external causes, as Bruises, &c. and lyes superficially under the Skin, they may be attempted by Chirur∣gery; yea tho' they lye deeper, provided they circumvolve no principal Vessel.

XXXV. But proceeding as a∣foresaid, from malignant Humors and corrosive Salts, tho' they may extirpated, yet the success will be doubtful: and tho' they seem to be absolutely cured, yet many times they breed again, and break forth either in the same place again, or in some other.

XXXVI. If it happens in the Head, Jaws, Cheeks, Neck, un∣der the Arm-holes, or Thighs, it is generally incurable; nor may the Actual or Potential Cau∣tery, or Excision be made use of; for those Parts are dan∣gerous to be cut, because of their Vessels, and the great flux of Blood that may ensue.

XXXVII. The Cure. Let the Diet, and regulation of the Non-naturals be as in a Scirrhus: Purge frequently, with such things as evacuate salt Phlegm, and Atra-bilis or Melancholy: avoid Bleeding, as most perni∣cious; as also Scarification, and the application of Suppuratives and strong Discutients.

XXXVIII. And if it is in a Woman whose Terms are stopt, cause them to return by Em∣menogogicks and Catharticks; and in Men the Hemorrhoids, where they have been accu∣stomed: and by Aperitives and Abstersive Medicines remove the Defect.

XXXIX. And inwardly, give the Spirit and Tincture of Tar∣tar; Tinctures of the Salt of Tartar, and of Antimony; Ma∣gisteries of Pearl, Oister-shells, Coral, Crabs eyes and claws; as also the Tincture of Luna, and Aurum potabile; which are to be given guttatim, in some proper Vehicle.

XL. But before you come to External Applications, you must consider whether the Cancer is recent and small, or inveterate and great; if recent and small, it sometimes admits of cure; but if inveterate and great, never,

without cutting off. And then, in this latter case, the Patient is to be consulted, whether he will be satisfied with a Pallia∣tive Cure only, or admit of Extirpation; if the last, we shall discourse of that when we come to treat of a Cancer ulerated: in this place then we shew the Cure of a small, recent Cancer; or the Pallia∣tion of a great inveterate one.

XLI. Now those things which only Palliate a large and invete∣rate Cancer, many times cure a small and recent one; of which kind, are these commended by Barbett: Roots of Aron, Drop∣wort, Figwort, Mullein; Leaves of Maidenhair, Housleek, Agri∣mony, Tobacco, Plantane, Night-shade, Hounds-tongue, Sperma Ceti, spawn of Frogs, burnt Toads, Crabs, Frogs, burnt Lead, Man's dung, Em∣plasters of Diapompholigos, of Saturn, de Ranis cum Mencurio, Diasulphuris, Camphir, Saccha∣rum Saturni, and Saccharum vel Sal Jovis, which Paracelsus commends, as the greatest of all Specificks: also Ʋnguentum Album, Nutritum, Populeon, Tutiae, de Plumbo usto.

XLII. Hartman says, he has cured many Womens Breasts, only with an Emplaster of Ammonia∣cum dissolved in Vinegar, and often repeating the same, to a perfect Cure; and he says he cured Ulcerated ones with the same, if you will believe him.

XLIII. ℞ Juices of Plantane, Endive, Housleek, Nightshade, Rose-vinegar, Cil of Myrtles, A. ℥i. Venice Turpentine ʒ ii. stir them together in a leaden Mortar, with a leaden Pestle; adding Saccharum Saturni, pouders of Pomgranate-peels, and of Citrons, A. ʒi. fine Bole, burnt Lead, Camphir, A. ʒss. mix, and make a Liniment.

XLIV. So also the simple Juices of Nightshade, Hemlock, Hen∣bane, Housleek, Endive, Succory, Lettice and Purslane are com∣mended; Cockle-fish boiled, and made into a Cataplasm; also River-Crabs, Crevises, and green Frogs, out of which an excel∣lent Oil is to be distilled by Descent, for the easing of the Pain, and abating the Tumor. See it in Our Doron Med. lib. 3. cap. 2. sect. 1.

XLV. Some make an Ʋnguent with the Ashes of Crabs or Craw∣fish, or Toads, mixed with Co∣riander-seed and Oil of Roses: also Metalline-Calces, washed, and freed from any biting quality: as of Lead, Tutia, Pom∣pholyx, Litharge, Ceruse, Anti∣mony, Marcasites, Jupiter; but Lead is very highly to be com∣mended by all, and may be used many ways.

XLVI. ℞ Terra sigillata, fine Bole, Ceruse, A. ℥ss. Tutia pre∣pared, pouder of green Frogs, A. ʒiii. Litharge ʒjss. Vinegar ʒvi. Oil of Frogs ℥i. Oil of Roses ℥jss. Wax q.s. mix, and in a leaden Mortar make an Ointment, which apply.

XLVII. And of those things which give a consistence to Juices, Pouder of Hermodacts, Calx of Jupiter and Saturn, Rye-meal and flower of Lupins are the best; because by a specifick

faculty, they allay the fierceness of a Cancer: so also Goats-dung mixt with Honey and Vinegar.

XLVIII. A Cataplasm of Snails and Alehoof is commended; and if it is painful, a Cataplasm of the pulp of Henbane and Hemlock roots, with Rye or Lupin flower, and Oil of Myrtles, is of good use. Or a Cataplasm of Frog-spawn, brought to a consistence with meal of Lupins: so also a Cataplasm of leaves of Herb Robert and Poppies.

XLIX. ℞ Oil of Quinces ℥ii. Vinegar of Elder or Roses ℥i. grind them in a leaden Mortar to a Liniment: 'tis a famous thing. Or, ℞ Emplastr. Dia∣palma ℥iii. juice of Nightshade and Henbane, A. ℥i. Oil of Roses ʒx. mix, dissolve, and make it of the consistence of a Liniment.

L. Aquapendens commends this. ℞ Garden-nightshade, Golden-rod, Sowthistle, A. Mji. boil in Water, bruise; and with Rye-meal lbi. Oil of Roses ℥v. make a Cata∣plasm. A Cataplasm of Radish∣seed and Vinegar is good; so also, a Cataplasm of Raisons ston'd, and leaves of Nightshade.

LI. A Preparation of Frogs, against Cancers. ℞ Live green Frogs N^o. 40. kill them, and fill their mouths full of Butter, which put into an earthen Pot well glaz'd, whose bottom is full of holes, and cover it: put this Pot into the mouth of another earthen Pot placed in the ground; lute these well together, and the cover of the upper Pot: then make a Fire of Charcoal about the upper Pot, which continue for five or six hours, to force down all the Moisture and Oil into the lower: which done, take the Frogs, and make them into fine pouder, which mix with the Oil per Descensum in the lower Pot: with which anoint the Cancer daily thrice a day.

LII. Paraeus commends a Plate of Lead besmeared with Quick∣silver: also this following Oint∣ment; ℞ Old Venice Treacle, juice of Lettice, Oil of Roses, A. ℥i. pulp of Crabs ℥ss. yolks of Eggs boiled hard N^o. 2. grind all in a leaden Mortar, to the con∣sistence of an Ointment.

LIII. Wiseman commends this. ℞ Pouder of green Frogs ʒiii. ashes of River-crabs ʒiv. Litharge of Gold ℥ii. burnt Lead, Tutia prepared, A. ʒii. Ceruse, ʒvi. juices of Nightshade and Plantane, A. ℥vi. Vinegar ℥ii. Ʋng. Populeon, Oil of Frogs, A. ℥iii. Veal-suet ℥iv. Wax q.s. mix, and make a Cerate.

LIV. Or, ℞ White Poppy seed ℥i. Henbane-seed ℥ss. Opium ʒi. Gum-Arabick ℥ss. make all into pouder, and mix with Oil of Roses and Myrtles, A. ℥iii. and with Wax q.s. make a Cerate; which is good in case of Pain, in ex∣tremity whereof, you may dou∣ble or treble the quantity of Opium.

LV. Many Mediums of this kind; for Cancers require variety of Applications, which are to be made of things which have a power to repress, discuss, and cor∣roborate; thereby not only to hinder the farther increase of the Cancer, but also to dimi∣nish, and quite take away that which is already in being.

LVI. But these Medicines ought to have a mediocrity in them, and not be sharp and biting; yet on the other side, if they be too weak, then they give no help or relief: but if they are too strong and violent, then they either repress and discuss the more thin parts, and so not only leave the more thick behind; but also render the Tumor the more unfit for future Applications, in order to their discussion or dissipation.

LVII. And while these things are doing, if the Patient has strength of Body, and vigour of Mind, and is willing, a gentle Salivation ought to be attempted; and if occasion be, to be twice or thrice repeated: for thereby the whole mass of Lympha, and all the Juices come to be re∣newed, so that a kind of new Ferment is begot in the Part.

LVIII. I speak this from Expe∣rience, having cured two remarka∣ble Cancers, (after much other means had failed:) one in a Woman about 30 years old, the other in a Woman about 36 years of age; where the Saliva∣tion was gentle, and continued in each about six weeks time.

LIX. And as to Purging and Diets, mentioned at Sect. 37. aforegoing, it is not enough that they be administred once, but are many times to be repeated; and that for the most part twice a week: for by that means, not only some part of the Humor will be revulsed from the Tu∣mor; but new matter, which would otherwise now, will be hindred, and taken away.

LX. Also, as to Topicks; if you apply hot and moist Medica∣ments, which usually suppurate Apostems, they will procure Putre∣faction in this: and if you apply Corrosives, you will assist the Malignity, and increase the Cancer.

LXI. If notwithstanding all that can be done, the Tumor still increases, and is in danger of Exulceration; it will be necessary to make the Patient acquainted with the danger: and if it is loose, and in a place where it may be safely extirpated, pro∣pose it to them in time; lest afterwards they do desire it, when it is late. If you come to Excision, the way and man∣ner of doing it, you may see Lib. 1. Cap. 33. of this Book, aforegoing.

II. A CANCER Ʋlcerated.

LXII. What we are to consider in an ulcerated Cancer, is either a Palliative Cure, or Extirpation: but if is fixed to the Ribs or Bone in any Part, or in a place dangerous, or not to be come at with Instruments, Excision also will be impossible.

LXIII. As for Diet, the Pa∣tient may eat Barley-cream, Rice-Milk with Water in it, Milk-Pottage, Ptisan made with Li∣quorice and the Opening Roots; Broths made with Borrage, Bu∣gloss, Endive, Succory, Spi∣nage, Lettice, Purslane, Sorrel; boiled in Broths made of Lamb, Mutton, Veal, Kid, young Hogs-flesh, Chickens, Pullets, Capons, Partridges, young Rabbets, &c. Fish living in clear and gravelly

Waters, Eggs, &c. a middling sort of Beer, not old; Mead, small Wines mixt with Wa∣ter, &c. they may eat Cucum∣bers, and things cooling and moistning.

LXIV. But Meats hard of digestion, heating and drying, are to be forborn; as dry Beans, Barley or Pease Bread, old Cheese, old and salt Flesh, old Rabbets, Hares-flesh, Venison, salt Bacon, Cabbage, Coleworts; as also all other things which thicken the Blood, heat, and inflame the Humors.

LXV. Purge also twice every Week with an Infusion of Sena, thus made: ℞ White-wine, fair Water lbiv. Salt of Tartar ʒii. Sena of Alexandria ℥ii. Liquo∣rice bruised ℥i. infuse in a Vessel close covered, in a boiling heat, for two or three hours, giving it at last a walm or two; then strain out being cold, for eight Doses; to be taken in the Morning fasting.

LVI. And in the intermediate days let the Body be kept with a cooling Diet, made with Fumi∣tory, Hops, and juice of fragrant Apples, with many Hog-lice bruised; abstaining from the things before commanded: as also from Garlick, Onions, Leeks, Shelots, Mustard, Pepper, and all other Spices: avoiding also grief, sadness, great labour, watching, and the like.

LXVII. Then outwardly dress it with Ung. Album, Nutritum, Tutiae, de Plumbo usto: or with this: ℞ Oil of Roses, white Wax, A.℥ ijss. juices of Nightshade and Pomgranates, A. ℥ ii. Ceruse, Aethiops mineralis, A. ℥ jss. Plumbi usti, Tutia prepared, A. ℥ss. Frankincense, Mastich, A. ʒii. mix, and make an Ointment.

LXVIII. Or, ℞ Ʋng. Tutiae ℥iv. Venice Treacle ℥i. Saccharum Saturni ʒi. juice of Cranes-bill q.s. mix, and grind them in a leaden Mortar to a consistence and blewness. Some commend Juice of Mullein boiled with Honey, or Tapsimel; others Valentia Pa∣paveris & Solani: Riverius says in his Observations, that he cured one by often dressing it with a mixture of Rose, Plan∣tane, and Corn-Poppy waters mixed with Mel rosatum.

LXiX. Or, ℞ Ʋng. Album, ℥ iv. pulvis Mercurii coagulati ℥ii. juice of Nightshade inspissate to the thickness of new Honey ℥i. Opium extracted, to the thickness of new Honey, with juice of Hen∣bane ℥ss. mix them in a leaden Mortar.

LXX. But if notwithstanding all the means that can be used, it cannot be kept at a stay, but that the Eating goes on, the Pa∣tient is in great pain, and Fluxes of Blood accompany it; it will then be necessary, to save Life, to come to the Extirpation of it: for the doing of which, Chirurgeons have three ways; 1. By Escaroticks. 2. By the Actual Cautery. 3. By Ex∣cision.

LXXI. 1. By Escaroticks. Hartman commends his Pulvis Benedictus, the Preparation of which see in our Doron Medicum, lib. 2. cap. 21. sect. 12. made of black Soot ℥iii. pouder of Aron-roots ℥ii. white Arsenick (ground

impalpable, and digested with Spirit of Wine) ℥i. mixed toge∣ther. This Pouder, the Ulcer being cleansed, is to be once, and but once strewed on, pretty thick; (unless it is taken off too soon, before the Roots are era∣dicated;) and an Oiled-cloth is laid over it, moistned with Fasting-spittle, that it may stick on.

LXXII. This procures great pain, but 'tis not to be removed till the Cancer and its roots are eradicated; anointing in the mean season round about it with Oil of Roses, or rather with Oil of Poppy-seed: when the pain ceases, and the Cancer is destroyed, remove the Pouder, and all that sticks to it.

LXXIII. Then cleansing the Ʋlcer, compleat the Cure with the Incarnative-pouder described in Our Doron Med. lib. 2. cap. 21. sect. 13. and the Litharge-Ointment described in lib. 3. cap. 4. sect. 22. of the same Book.

LXXIV. Others commend Oil or Butter of Antimony, anointing it round therewith: but not∣withstanding this, if the Cancer is great, it ought with a Knife to be wholly cut off to the quick: or by burning it with Actual, or Potential Cauteries, to be removed.

LXXV. Some wash it with Water, Spirit or Oil of Soot, till an Escar is made; then apply Oil of fixed Arsenick (washed in Water) till the Ʋlcer is throughly cleansed. Or else strew on red Precipitate, or a Precipitate made with amalgamated Sol: after which it is healed with the Incarnative-pouder, and Li∣tharge-Ointment.

LXXVI. Others, when the Can∣cer is mortified, and the Ʋlcer cleansed, heal it with Balsam of Sulphur and Empl. Diasulphuris; giving them thro' the whole Cure, the Sena-Infusion before described; and a Diet-drink made of a great number of bruised Sows or Hog-lice, (often to be repeated, and for a long time to be used) infused in half White-wine, half Water.

LXXVII. Riverius in one of his Observations, commends the Escarotick in lib. 1. cap. 33. sect. 10. of this Work aforegoing, applied as there delivered. But he fays the Paste may be spread upon a Bolster six times lesser than the Cancer, which may lye upon it twenty-four hours, and it will make an Escar six times greater than the Bolster: with∣out doubt it ought to be much less than the Ulcer, because of its aptness to spread; yet not six times lesser.

LXXVIII. This Escarotick (says he) did eat the Cancer wholly away; and when the Escar fell off, the Ʋlcer was filled with flesh, and then healed up. But in case the whole Tumor had not been taken away, but some roots had remained, they must have been consumed with a mixture of red Precipitate and burnt Alum, well mixed together.

LXXIX. To incarnate the Ʋl∣cer, dry Lint was only used: but while the Paste was on, a Fever was presently excited, with vo∣miting, flux of the Belly, and

great provocation of Ʋrine; which Symptoms continued two or three days, Nature being of∣fended with the violence of the Escarotick: with the same Medicine a Cancer upon a Sol∣dier's Nose, which had eaten away the tip of it, was Cured.

LXXX. But Wiseman says, that by the use of these Escaro∣ticks, young Chirurgeons have been sometimes engaged to their preju∣dice; and that an eminent Chir∣urgeon undertook the Eradi∣cating of an Ulcerated Cancer in the Breast of a Woman who had strength, and courage to endure it: he applied one of the strongest Escaroticks, which penetrated deep, and made great sloughs, and by repeating the Escarotick, raised new.

LXXXI. But the use of it was not long continued; for the Gleet partaking of the Corrosives, ul∣cerated the adjacent parts; and the Cancer was so enraged by the Escarotick, as shewed that there was no good to be done by it.

LXXXII. Indeed (says he) if we could contrive Medicines, which may penetrate deep, with little pain, there might be some hopes of success: but 'tis evident that cancerous Excrescencies, and cancerous Ulcers of the Mouth are increased, by touch∣ing them with Oil of Vitriol or Sulphur, &c. upon which considerations, it seems, that there does remain, but three ways of treating a Cancer; viz. either by Palliatives, or the Actual Cautery, or Excision by the Knife.

LXXXIII. The Palliative Cure we have already shewed, which only hinders the farther augmen∣tation, and eases the pain; so that the Sick may lengthen out, and lead the remainder of his life with less torment and misery. Now to the things there enu∣merated, you may add Empl. de Ammoniaco made with Vin∣egar, Ceratum de Ammoniaco Foresti; Emplastrum de Galbano crocatum, Emplast. de Ranis with fourfold Mercury, or Our Empl. Mercuriale.

LXXXIV. 2. By the Actual Cautery. If the Cancer is in such a place, as you are in hopes to eradicate it, the Actual Cautery is then a certain Cure; but not by applying it lightly upon the upper parts; but by thrusting down to the root, with a Scoop, or Chezil-like Cautery, carry∣ing it away before you.

LXXXV. If there remains any rags, or roots of it, burn it down to a crust, with a proportionable Button-cautery: if this cannot be effected, then Palliatives are to be used, as are above di∣rected; by which means, the poor Patient who has an ulcera∣ted Cancer, may live tollerably well.

LXXXVI. 3. By Excision. Before you do this, see the Patient is fit for it; as having strength of Body, of a tollerable good habit, and not in a very declining age; that the Cancer is loose, and the Arm-pits and parts under it, be free from painful Glandules: and it would be better, if the ori∣ginal of the Cancer was from some external Accident, as a

Blow, &c. and the Operation to be done in the Spring or Autumn of the year; not in the extream heat of Summer, or cold of Winter.

LXXXVII. Then have in a readiness, 1. Good Rowlers. 2. Compresses or Bolsters. 3. Pled∣gets. 4. Defensatives. 5. Astrin∣gent or Styptick pouders, as in other Amputations: but Calcan∣thum, or calcin'd Vitriol, or other Escarotick-pouders are not good; for you cannot apply them to the mouths of the Arteries, but they will corrode the adjacent parts, and cause much pain, which ought not to be in Cancers: besides, they also require a strict Bandage, which is not without much trouble, on the Brest.

LXXXVIII. Wiseman propo∣ses the stopping of the Blood with a small Button-cautery, which (says he) is not done without some pain, but it is momentary, and serves to correct the indispo∣sition of the Part: these actual Cauteries ought to be of dif∣fering sorts, and kept ready hot for use; lest some relick of a Cancerous Gland should be left behind.

LXXXIX. But that very skil∣ful Man, Dr. Gardner, the Kings Chirurgeon, seldom or never stops the Blood, in this case, with the Actual Cautery; but always makes a provision of proper Stypticks, not corrosive; which he prepares from the Caput mortuum of Vitriol: which are always so effectual, as never to fail the purpose they are intended for, and ever stop the Hemorrhage, without any pain. These things done:

XC. Having placed the Pa∣tient in a Chair, take a couple of large Needles, with strong silken Strings, or others; which pass through the Cancerated Breast crosswise, towards the bottom of the Cancer; and taking these four ends tye them together, by which you are to hold, while you are doing the Operation. Then taking the Strings in your left hand, take the Knife in your right hand; which ought to be large, viz. long, broad, and very sharp: and beginning at the top of the Breast, cut it downwards; and with two or three cuts, cut it close near the Rib, and wholly off, so as to leave no part of the Cancer behind.

XCI. But others, instead of the Needles and Strings aforesaid, because their use seems to be fright∣ful and painful to the Patient, provide a kind of Forceps, turn'd at both ends in form of a Crescent, like Callaper-compasses; in such sort, that both ends may fall one upon another when shut; and with these Callapar-Forceps they lay hold of the Breast, and hold them with the Breast between them in their left hand, whilst they perform the Operation as aforesaid, with their right.

XCII. The Breast being thus cut off, the thicker Blood is every where pressed forth, and with Spunges wiped away; and the mouths of the Vessels are either closed with the Actual Cautery: or some proper Styptick with

Pledgets, is applied; and the whole is drest up with Astrin∣gent Pouders, as Pulvis Ga∣leni, &c. (which Wiseman used) a Plaster, a Bolster, a folded Napkin round the Breast, and a Scapulary, to uphold the whole Bandage, and keep it tight and firm.

XCIII. The Operation being done, and the Wound bound up; let the Patient be laid in her Bed, giving her upon the spot a little sup of Our Aqua Bezoartica, or some other Cordial Water, to revive her fainting spirits; and presently after an Anodyn-Draught, to allay the Ferment; such as this: ℞ Aqua Bezoar∣tica ʒvi. Aquae Menthae & La∣ctis, A. ℥jss. Spirit of Sal Armoniack, Guttae vitae, A. ℈ii. mix them, for a Dose.

XCIV. The next day after, either repeat the same Dose, or give Venice-Treacle or Mithridate, or Our Theriaca Chymica; which may be used as Antidotes against the malignity of the Disease, and virulency of the Humor.

XCV. The second or third day after, dress it with some Digestive; as with Turpentine, mixt with the yolk of an Egg: or with this; ℞ Venice or Strasburgh Turpen∣tine ℥ iii. juices of Nightshade, Plantain and Smallage, A. ℥ii. Syrup of Roses ℥jss. boil to the consumption of the Juices; then add Barley-flower, meal of Cicers, A.ʒiv. Saffron ʒii. yolk of an Egg, mix them.

XCVI. If there is pain, you may apply this Anodyn over it. ℞ Mucilage of Althea-root lbj. Wheat-meal, ℥ii. Oil of Roses ℥iii. boil to the thickness of a Cata∣plasm, adding at the end of the boiling, yolks of Eggs N^o. ii. Saffron ʒi. mix them: but if there is no pain, dress it up with Emplastrum C saris, or è Bolo.

XCVII. After Digestion, cleanse with Detersives, then bring on the Flesh with Incarnatives, and with Epuloticks cicatrize, as we shew in Curing of Wounds; and while these things are doing, things which purge Atra-bilis are often to be repeated; the Infusion of Sena aforesaid, and the like; or the Body is to be kept soluble with Cly∣sters.

XCVIII. If in Cicatrizing, the lips should grow callous, eradi∣cate it timely by the Actual Cau∣tery, whilst it is recent, and in a narrow compass, lying but on the superficies: for if you slight it, till it has seized the muscu∣lous Flesh, it will be too late, and then scarcely capable of a Palliative Course.

XCIX. Whereas, in the Appli∣cation of Escaroticks, mention is made of using crude Arsenick; Sennertus says, it cannot be ad∣ministred without much hazard and danger; and that Arsenick fixed by melting it with Nitre; by which a fixed Salt of Arsenick is made, divested of much, or most of its malign and poi∣sonous quality, is much more safe to be used.

C. And lastly, because Cancers are very apt to return again, the Body ought to be kept for some time after the Cure, with proper

Diets, made of Fumitory, Hog∣lice, dried Toads flesh, Vipers flesh, &c. and a constant and due Purging at certain intervals of Time, with such things as evacuate Atra-bilis; as Sena, Hermodacts, Scammony, black Hellebor, Lapis Lazuli.

CHAP. XXXVII. Of a CANCER of a BONE.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Cancer de Osse, Spina ventosa; and in English, The Cancer of a Bone.

II. Definition. It is a preter∣natural, hard, and painful Tumor of the Bone; arising within the Bone, or between the Bone and the Periosteum.

III. The Causes. The Proca∣tartick Causes may be the same with those of a Cancer, or of hard strumous Tumors; for which reason, some will have it to be a species of the Kings-Evil.

IV. The Antecedent Cause, is a sharp Humour, or thin acid Serum, in the Medullary-juice; which corroding the Bone, makes its way thro' the Peri∣osteum; after which there fol∣lows an Ulcer of the Flesh and Skin, which is incurable, till the Bone is made sound.

V. The Conjoined Cause, is that sharp Humor or Scrum, separated from the Blood and Lympha, which seizes upon the Fibres, and make a solution of continuity there, corrupting at length the inte∣rior part of the Bone it self; passing its subtil and malign Humor thro' the porosities it had made.

VI. This sharp malign Humor by degrees so affects the external surface of the Bone, as to raise thereon a preternatural Tumor, which extending the Periosteum, causes much pain and torment: which pain, if it grows so sharp, as to cause an Inflammation, then an Abscess or Apostem suc∣ceeds, and therewith a fetid, painful Ulcer, difficult to be cured.

VII. The Differences. They arise, 1. From the Humor. 2. From the place of its Begin∣ning. 3. From the Parts af∣fected.

VIII. 1. From the Humor. The milder the Humor is, the slower the Tumor arises, and sometimes scarce any swelling appears, or any pain is felt; gradually swelling, and never corrupting exter∣nally. The sharper the Humor is, the sooner the Tumor arises; so that sometimes it appears in 24 hours, passing thro' the cor∣tex of the Bone, and imme∣diately (as it were) causing an Abscess.

IX. 2. From the Place. For it begins either within the Bone,

or without the Bone, between the Cortex and the Periosteum; and according as the interior part is harder or softer; or the external Cortex is solid, or porous, so it suffers solution sooner or later.

X. 3. From the Part af∣fected: as, 1. In the Cranium, where the Humor passes for the most part thro' the inferior Lamina, affecting the Dura ma∣ter, &c. causing great Pain, Spasms, Convulsions, Epile∣psies, &c. this is seldom dis∣covered before death. 2. In the great Bones of the Knees, Shins, Ancles, Elbows, Cubi∣tus, &c. where the Humor increases but slowly, and gene∣rally produces Apostems, arising externally from the protube∣rance within. 3. In the Os Tali, or Heel-bone; which is spungy within, and full of external Pores, in which it makes its way speedily. 4. In the Jaw-bones, which are some∣thing porous also. 5. In the Toes. 6. In the Fingers ends; where it is called Paronychia, or a Felon; of which we have already treated, in Chap. 12. aforegoing, of this Book.

XI. The Signs. The most visi∣ble Signs, are a protuberance or swelling of the Bone, without dis∣colouring of the Skin; which is either with much pain, or with∣out much pain; according as the Humor causing it is either sharper, or milder.

XII. It is known also by the Apostem arising there-from, which is always between the Membranes and Tendons: and something of Fluctuation may be felt, be∣fore the external Skin is much inflamed.

XIII. The Apostem being opened, if you then search with a Probe, you may many time find it pene∣trates deep into the Bone; and yet the Cortex of it will be white: whereas in other Apo∣stems, which begin externally, when the Bone is bare, it will be only superficially carious, and stained with the matter.

XIV. The Orifice, says Barbett, is very little, the edges are paler, the matter which flows forth, is thin; the Flesh is soft, and somewhat swell'd, at least (as in an Ulcerous Excrescency) it increases of its own accord.

XV. Where it affects a Bone that is spongy, it is admirable to see how quickly the Fibres of it will be softned, by the sharpness of the Serum of the Blood, and made apt for a sudden disten∣tion; as if it were rather Mus∣cular, than Boney.

XVI. The Prognosticks. This Disease is always of difficult cure: and Barbett says it is incura∣ble, unless the Bone be made sound.

XVII. It is more easily cured in the lesser Bones; as the Cra∣nium, Jaws, Fingers, and Toes: but if it is in the larger Bones, it is for the most part desperate; and if at length performed, it is very long first.

XVIII. Infants and Children are most subject to this Disease; because their Bones are softer, and more porous: Old persons are seldom troubled with it, for the contrary reason.

XIX. The Bone thus swelling, or seeming to have an Exostosis upon it, as being big, and seeming to be very hard; yet if you open it, it will be found in∣wardly carious, or spongy and rotten.

XX. The Cure. The same method is to be taken here, as is proposed in Apostems and Ʋlcers with Caries: seeing when this is Apostemated or Ulcerated, it is nothing more or less, than such a Disease; except you will say the Humor is yet more sharp and malign.

XXI. If it is not ulcerated or broken, if very painful, you must first of all use Incision; which must be made according to the length of the Part, and that to the Bone it self: for the sooner this sharp corroding Humor is let out, the better it is, and withal pre∣vents more mischief, which by its being longer retained with∣in, it would do.

XXII. Being opened, you must dress it with things astringent, drying, and resisting Putrifaction; as Euphorbium, Spirit of Vi∣triol or Sulphur mixed with Spirit of Wine, Tincture of Myrrh, camphorated Spirit of Wine.

XXIII. But before opening, while the Disease is recent and young, (a good Diet, and regulation in the Non-naturals being observed) you ought to purge the Body well with proper Catharticks, and use a good Diet-drink; such as we prescribe in strumatick Tumors: and outwardly things astringent and drying; as Emplast. e Bolo, Empl. Caejaris, de Minio simplex, & cum Sapone; Empl. de Ranis cum Mercurio; or Our Empla∣strum Mercuriale, &c.

XXIV. But after opening as aforesaid, Barbett commends the Pouder made of Turpentine, by boiling it in Water to hardness: he commends it as an excellent thing upon his own Experience, being mixt with Ʋnguent. Fu∣scum Wurtzii, or Aegyptiacum: an actual Cautery also, says he, will be convenient.

XXV. The Cure will also be accelerated, if instead of Tents made of Lint, Elder-pith be used; because it imbibes the thin and sharp Humors, by which the Action of Nature is promoted.

XXVI. This is an experienced thing. ℞ Ʋng. Aegyptiacum ℥ii. Tobacco in fine pouder ℥ss. Euphor∣bium ʒi. mix them, and apply it. You may daily wash it also with Juice of green Tobacco, raised from Spanish seed, or with a Tincture of dried Tobacco, drawn with S.V. or with Spi∣ritus Ʋniversalis.

XXVII. If it is in the Cra∣nium, it is not protuberant, yet you ought to make inspection; and proceed accordingly by scra∣ping, or the Trepan, as the Symptoms shall indicate to you.

XXVIII. Those in the Jaws are visible, and require vent by extraction of the Teeth: after which the Caries must be con∣sumed or removed, by drying Applications; of which the Actual Cautery is the most speedy and convenient.

XXIX. The Ʋlcers in the greater Bones, are to opened also; that the matter may be

discharged, and the Bone laid bare, in order to Exfoliation, if possible.

XXX. But if the interior part of it is corrupted, then it will be best to keep that part of the Ʋlcer dilated which lyes over the aperture, and in the Bone, by some Dossel dipt in S.V. or Camphorated Spirit, or Tinctura Exfolians, and to heal up the rest of the Ulcer; prescribing also such Internals, as may dispose the Body to a better habit.

XXXI. For seeing that for the most part these Diseases arise from the distemperature of the whole mass of Blood and Lympha; and that when one Cancer is almost cured, another appears in some other place; therefore it is highly necessary to have regard to the evil habit of the whole Body: for which purpose, the following (or some such-like) Medicine may be taken.

XXXII. ℞ Roots of Comfrey, Osmond-royal, China, Sarsaparilla, A. ℥ii. bark of Guajacum ℥iv. Rhu••arb, Agarick, A.℥jss. Sena ℥ijss. Cinamon ℥ss. Cloves ʒii. infuse all in Barley-water lbxii. or q.s. then boil with a gentle Fire to lbviii. Strain, and dulcifie with Syrup of Comfrey ℥viii. and make an Apozem. Dose, ℥iii, iv, or v. to a Man or Woman: it Purges gently, hastens the Cure, and preserves from farther mischief.

XXXIII. Those of the Fingers and Toes are to be laid open by Incision, in case of Apostemation, the length of the Protuberance and the Bone cut into, or cut out, as you see the case requires; and then the Caries dried up, with such things as are before re∣lated. ℞ Mel Rosarum ℥ i. pouder of Tobacco ʒiii. Euphor∣bium, Camphir, A. ʒi. mix them.

XXXIV. The greater Bones will take more time to exfoliate them; and if the rottenness begins within it, it will consume the very substance of them; so that no Exfoliation can be expected, but a total removing of the Bone it self, without which no Cure can be expected: and in this case, Nature it self is so munificent, as sometime to supply the vacuum with some Callus, or Cartilaginous substance.

CHAP. XXXVIII. Of an ELEPHANTIASIS.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Elephantiasis, Lepra Ar••bum; and in English, the Elephantiasis, or Elephantick Disease, the Ara∣bian Leprosy.

II. The Name is derived from the Elephant; because those af∣fected with this Disease, have

their Skin, and Members af∣fected therewith tumid and swoln, scaly, rough and rugged, full of lumps, and unequal, like to the rough skin of Elephants. Of this Disease we have spoken at large, in the third Edition of Our Synopsis Medicinae, lib. 6 cap. 15. so that little need be said of it here; excepting what belongs to the Chirurgick part, which is contained in this present Discourse.

III. Description. The Lips of such as are troubled with an Ele∣phantiasis, are made thick, and the Nose swells; so that it looks as if it were pressed down, or become flat; the Ears become flaggy, and much wasted, the Jaw-bones are coloured as it were, and overspead with a certain kind of redness, and Tubercles or swel∣lings appear here and there in the Forehead, like as if they were Horns or bunchings-out; the Cheeks and Face are also affected with a certain roughness and redness; and the Chin it self is dilated, like as it is in those that laugh.

IV. It is said to be indeed an universal Cancer of the whole Body, comprehending under it many kinds of Diseases: so that this appears to be an Affect greater than all other Diseases, and a Disease almost remediless and incurable.

V. The Causes. Authors say, it arises from Atra-bilis joined with a malign property, diffused and spread abroad thro' the whole Body.

VI. But doubtless it is caused thro' a Discrasy of the Blood and Lympha, defiled with a kind of Arsenical or stinking Sulphur, and a malign Vitriolick Salt; which being conveyed with the Blood and Lympha all over the whole Body, and altering the Fer∣ment thereof every where, causes this so universal a defile∣ment.

VII. The Antecedent cause is from a hot and dry distemper of the Viscera, and Parts destinated for Nutrition: from whence it is, that the Blood and Lympha are as it were burnt, or very much altered, by the evil Fer∣ment of the Parts; and they being changed, make in their distribution, that universal change thro' the whole Body, which is usually seen in the pro∣gress of this Disease.

VIII. The Procatartick Cause is a lewd, debauched, luxurious, libidinous and evil course of Life: the frequent and common use of salt Meats: as also the much eating of great quantities of Sugar, and of sharp and sowr things, or Meats overgross and thick, eating of Mans-flesh, and the like.

IX. To this add the Habit of the Air; for this Disease being mostly Endemical, it is chiefly to be found in some particular parts of the World: where 'tis thought the Air contributes much to its beginning, growth, and in∣crease; as in Aegypt, Palestine, Arabia, Africa, Spain, in some parts of Italy and Germany, and in Narbon and Aquitane in France: as also the Air in which Elephantiack persons breathe; for that the Disease is

affirm'd to be certainly conta∣gious.

X. The Kinds. It is said to be twofold: 1. General; of the whole Body, which is called Elephantiasis Graecorum, or Le∣pra Arabum; of which we speak in this Chapter. 2. Particular; which only affects a Part, and is called Elephantia, or Elephantia∣sis Arabum; of which we shall (God willing) speak in the next Chapter.

XI. The Signs. Celsus, lib. 3. cap. 25. has given you the whole Idea of this Malady, which you may see at large in Our Synopsis Medicinae, lib. 6. cap. 17. sect. 7. to which we refer you: and Sennertus has given you a larger enumeration of the attending Symptoms: all which you may see in the place afore-cited, from Sect. 8. to 14.

XII. To these aforesaid Signs, declared by those Authors, we add these following: 1. There is an augmentation of Magnitude in most parts of the Body; it being swel∣led up and down, especially in the external Parts; whose beauty, feature, and figure are thereby corrupted.

XIII. 2. There is also a hot and dry Distemper, by which the Parts of the Body are made uneven and rough, and as it were exul∣cerated and corrupted.

XIV. 3. There is also in Men a suppression of the Hemorrhoids, where they have been usual, and long accustomed; and in Women, a stoppage of their Terms or Courses: or the sudden drying up of some long-continued running Ulcer; whose Humor being detained in the Body, grows worse and worse, and at length acquires Malignity; which insinuating it self into the Veins, infects and taints the whole mass of Blood.

XV. 4. When this Disease is first invading the Patient, there goes before it, and is present, a sluggishness, or slothfulness, with a slow and difficult breathing; a stinking Breath, unfitness for motion; a daily and continual Costiveness of the Belly, and the Urine is like unto Beasts Urine; as Horses, Bullocks, Oxen, and an extream prone∣ness to Venery.

XVI. 5. The Voice is hoarse and obscure; by reason that the Lungs, and parts serving to Re∣spiration, are filled or oppressed with thick and adust Humòrs: and by reason also of the driness and roughness of the Trachaea Arteria.

XVII. 6. The Veins under the Tongue swell, and become blackish; and the Glandules which lye near unto the Tongue, and round about it, have in them round Tubercles, like unto the Scrophulae in Swine, or those which we call the Swine-pox.

XVIII. 7. In a word, the whole Body is defiled with an exceeding great pollution, and a great de∣formity attends every part thereof: it wants either in its figure or shape, b••ing either greater or less than it should be, in all its Members. The surface of the Sain is changed, being red and dis∣coloured, hard, scur••fy, and full of little Tubercles, not much unlike the Elephants hide or

Lion's forehead: the Voice is altered, and sometimes almost gone; and the Breath so abo∣minable, as not to be endured.

XIX. The Prognosticks. This Disease is said to be wholly in∣curable, unless taken in its begin∣ning; and then it is performed with very much difficulty, great trouble, and a tedious application of Medicines; for that few Me∣dicines are found, that can sub∣due and conquer the malignity thereof.

XX. And by reason that this Disease discovers not it self soon, nor is at all manifest, 'till it has taken deep root, and tainted all the Blood and Humors with the greatest Malignity; so that it has (as I may say) fixed it self thro' all the Bowels, and the whole Foundation of the Fleshy Mass, and even corrupting them throughout, for these Reasons, it is esteemed by all Authors to be incurable.

XXI. But yet, as it would be great folly to attempt this Cure where the Disease is inveterate, or has been of long standing, so as that it has corrupted the whole Body: so it would be as great a weakness and inhumanity, to deny our help and assistance, for the Cure of such as only seem to be affected therewith, but are indeed not so diseased; or where it is yet but in its infancy, or beginning.

XXII. Actius, Tetrab. 4. serm. 1. cap. 120. saith, Huma∣num enim, & plenum benevolentiae signum est, in extremis malis, etiam usque ad Experimenta ve∣nire, ad difficultatem Affectionis compescendam: viz. For (says he) it is humane, and a great sign of good nature, in the greatest extremities, or the worst of Diseases, to make such Trials as may possibly tend to the benefit of the Sick.

XXIII. The Cure. For, what Diet is necessary, or what things are to be avoided; we shall refer you to the third Edition of Our said Synopsis Medicinae, lib. 6. cap. 17. sect. 26. ad 31. and come now immediately to the Medicinal and Chirurgick Cure.

XXIV. The Humor ought often to be evacuated, which let be chiefly with Mercurial Prepara∣tions: and outwardly a Cataplasm of green Tobacco, mixt with pouder of Bay-berries q.s. is to be laid all over the Belly, and kept there so long as the Patient can conve∣niently endure it: for it works both upwards and downwards, and purges the whole universal Man; evacuating all offending Humors, of what kind soever.

XXV. And this Application is to be repeated; and that so often as the age, strength, habit of Body, and condition of the Sick will permit.

XXVI. But the most potent of all internal Remedies, are such as operate by Salivation; be∣cause they drain away all the impure Lympha in the whole Body; throughly purge and alter all the Mass of Humors, and do as much as is possible to be done by any kind of Eva∣cuating-Medicines.

XXVII. And tho' by this way the Humors and Juices are much sweetned, and altered; yet it is

to be imagined, by reason the Disease is so deeply fixed in the fleshy Mass and Humors, that one single Salivation cannot perform a compleat Restauration; but that it must be many times, and often repeated, sometimes by Internals only, and sometimes by Externals, as by Unction: because the whole substance of the Flesh, and the Skin also, seem to be throughly defiled therewith.

XXVIII. And by reason this kind of Operation much weakens the Body, there is to be that di∣stance of time between each Sali∣vation, as that the Patient may be restored, and gather a compe∣tency of strength again: for to continue it too long, or to repeat it too soon, one time after another, are equally dis∣advantageous to the deplorable Patient.

XXIX. For Alteratives, we commend the Viper-pouder, to be taken ʒi. at a time, every Night going to bed, when the course of Salivation is over; or in the times between each Salivation: and every Morning fasting, the Pote∣states Viperarum; which may be given, à gutt. 20. ad 40. in Mead, or clarified Whey, or some other proper Liquor or Vehicle.

XXX. To these things we may add, native Cinnabar, Tincture of Antimony, Mercurius Diapho∣reticus, Bezoar-mineral, pouder of Toads-flesh, (long to be continued, because it is a Spe∣cifick) the pouder and ashes of Kites-flesh, wonderfully com∣mended by Sennertus; and the Specifick of Vitriol, so much extolled by Hartman: which may be given singularly, or rather alternately; because Na∣ture delights in variety and change, and that for a long time together.

XXXI. But for Alteratives, nothing seems to have more and greater effects than the Tincture of Luna, and Aurum potabile; which have a power to alter and change, cleanse and purify the whole mass of Blood and Humors, after a very admirable manner; and to drink withal, for some considerable time, the Decoctum Ʋlmi, as ordinary Drink, because it seems to be specifick in this Cure.

XXXII. Barley-broth made with Vipers-flesh, taken for many Months together, is a singular Experiment. And because the whole Diet in this Cure ought to be cooling and moistning, and withal cleansing, we com∣mend Whey clarified with Fu∣mitory, or with Borrage and Bugloss, Endive and Succory, Sorrel, and sharp-pointed Dock, Purslane, Lettice, &c.

XXXIII. And Sennertus says, that this Disease more than any other, seems to require as it were variety, and an interchange of Remedies; and also certain ces∣sations and intermissions, from all sorts of Medicines: and then the same are to be used again afresh, and new ones are to be added; for that scarcely ever any one did recover of this Disease, that placed the hope of Cure in one only Preparation, tho' it were never so generous and prevalent.

XXXIV. Thus much for Inter∣nals: we now come to Topicks; among which Sennertus commends a Bath of fair Water, in which the Patient may sit up to the Neck for the space of one hour. But, says he, the Bath ought to be so temperate, that no Sweat may be caused, either in the Bath, or after the going out of it: for if any Sweat is caused, it is a sign that the Bath is hot∣ter than it ought to be.

XXXV. 'Tis true that many Physicians send their Patients to the Natural and Mineral Waters, and hot Baths; but because they dry vehemently, they many times do more hurt than good; especially at the beginning of the Disease, whilst the heat and driness are at highest.

XXXVI. And therefore a Bath of sweet fair Water is thought to be more proper and safe; because it tempers the driness, discusses the Excrements of the external habit, and looseneth the Skin: but it ought often to be re∣peated, even twice a day, and that for several Months toge∣ther.

XXXVII. And every time owning out of the Bath, the Skin ought to be anointed with some fat thing; as Vipers-grease, Man's-fat, Oil of Toads, Oil of Ben, &c. to keep the Skin soft and smooth: or a cooling Ointment may be made of the juices of Nightshade, Henbane, Hem∣lock, and Poppies, for the same purpose.

XXXVIII. Some commend the p•…•…der of the roots or leaves of ••ack 〈◊〉〈◊〉, as much as the quantity of a large grey Pea, or somewhat more, to be put into a new cut Issue, whether in the Arm, Shoulder, or any other pro∣per place; and to be kept there∣in for some considerable time, as the Artist shall see convenient; viz. 'till it causes a very great Tumor, and mighty Flux of Humors to drain through the same.

XXXIX. This Application is so powerful, that it needs not twice to be repeated; and it attracts the Humors so powerfully from all parts of the Body; and so plentifully, that no Salivation is comparable to it; nor yet any other kind of Evacuation, whether inward or outward: and being used in many other Diseases, it will never cease running, 'till all the Morbisick-matter is per∣fectly drawn away: for it com∣pleatly drains all evil, corrupt and malign Humors, from all parts of the whole intire Man.

XL. Places full of Scurf, Scales, and dry Scabs may in time of Bathing be often rubbed with common Soap, to loosen them, bring them off, and dry them: and the largest Scales, and such as stick fast, Wiseman rubs with the Caustick-stone; which did not only hasten their falling off, but also scowrs the Skin excel-

XLI. And where the bigger Scabs separate, there remains for the most part a discolouring, and little Excrescencies of Flesh, by which those Scabs were held so close on, as if they were nailed fast: these Excrescencies he rubbed off with the Caustick-Stone, and where there was

occasion, dressed the Parts with Ʋnguent. Tutiae, or Ointment of Litharge.

XLII. He also Bathes in warm Water, rubbing the Body with Balls of Wheat-bran and Soap; which he continues for several days, till the Body seems to be clear. Sometimes he Bathes in warm Water, wherein he dissolves a small quantity of corrosive Sublimate; and alternately uses Salivation for twenty or thirty days together, repeating the Salivation with Turpethum mi∣nerale and Ʋnguentum Neapolita∣num by turns, till the surface of the whole Body is cleansed of all its Defilements.

XLIII. From what hath been said it appears, that other Baths than that of fair Water may be used; as a Lixivium of Quick∣lime, Spiritus universalis made very weak, a Decoction of Flowers of Sulphur and Salt of Tartar in fair Water, a De∣coction of Hellebor-roots; a Solution of Saccharum Saturni, Nitre, or white Vitriol in fair Water; a Decoction of Tobacco, and the like.

XLIV. These things alter the Humors very much, and overcome the Malignity almost to a wonder: but because they dry vehe∣mently, therefore several Au∣thors speak much against them.

XLV. But there is no Argument against Experience. I know them to do good upon my own Expe∣rience; and there is nothing to be objected against them, but their great drying property: to remedy which, we prescribe: 1. To Bathe with these kinds of Baths one time, and then with simple fair Water another time; and so to use them alternately. 2. After bathing with them, to anoint all the whole Body with Oil of Ben, rubbing it very well in; or using some other sweet and cooling Oil, or Ointment.

CHAP. XXXIX. Of the ELEPHANTIASIS of a PART.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in La∣tin, Elephantia, vel Elephan∣tiasis Arabum; in English, The Elephantiasis of a Part.

II. Definition. It is a preter∣natural, irregular, and cancerous Tumor of the Feet; deforming them, and making them thick and bulky, not much unlike to Elephants Feet.

III. The Causes. It is said to be caused originally from Varices, and to arise from Melancholick and Phlegmatick Blood; or ra∣ther, the Recrements of the Bloody-juice, setling upon the depending Parts; as the Legs, Ancles, Feet.

IV. The Signs. Haly Abbas, in Theoric. lib. 8. cap. 18. saith, Ʋlcera quae in Pedibus & Cruri∣bus siunt, Elephas vocantur; & Elephanticus Morbus Apostema est Melancholicum, quod in Cruribus fit & Pedibus; & ejus si••num est, quòd Pedis figura Elephanti figurae similis sit: viz. Those Ulcers which arise in the Feet and Legs are called Elephas; and the Elephantick Disease is a Melancholy Tumor or Swel∣ling, arising in the Legs and Feet; and the sign thereof is this, that the shape or figure of the Foot, resembles the form of an Elephants Foot.

V. The Foot, or Leg, and some∣times both, become a very great irregular Tumor, and of an ex∣ceeding thickness: the Legs are tumid, and much swoln; very red sometimes, sometimes wan and livid, and sometimes black.

VI. And besides the irregula∣rity, this Tumor is sometimes full of little Tubercles, and dry Scabs; and sometimes it is abounding with Ulcers.

VII. And as to its magnitude, it is often so great and irregular, that not only the form of the Foot is lost, but also the Toes are so swallowed up and hidden, as they can scarcely, and sometimes not at all be seen.

VIII. This kind of Disease you may often behold in Beggers, by the High-ways, and corners of Streets; who get their Liveli∣hood, by begging in those publick and common places: I have often seen them as I have passed up and down Cheapside, London; lying in the passage, to move peoples charity, as they gazed on them.

IX. The Prognosticks. It is difficultly cured without a long and continued course of Physick; and if it once becomes invete∣rate, it is for the most incura∣ble: because that from all parts of the Body, abundance of Humors are protruded, and thrust down thither.

X. The Cure. It is done by a long and continued evacuation of the Morbifick-matter, with those things we have before men∣tioned in the Cure of an Ele∣phantiasis Graecorum, in the for∣mer Chapter.

XI. For unless those vitious Humors be often evacuated, and emptied forth of the Body; and the evil disposition of the Bowels (from whence those Humors are supplied) be cor∣rected and amended, there can be no hopes of a Cure.

XII. The sum therefore of the Cure, consists in a long and conti∣nual course of Physick, as is pro∣per for so contumacious and rebel∣lious an Affect, and a perpetual evacuation of the Morbifick-matter; which can best be done with a course of Salivating only, and oft to be repeated at due intervals of time.

XIII. During the doing of which, the growth and increase of the Tumor is to be prevented, by Medicaments partly astrin∣gent and drying, and partly by Discussives and Resolvers, alternately used.

XIV. Of which kind are, Bawm, Camomil, Elder-leaves, Fennel; roots of round Birth∣wort,

Orrice; Gums, as Ammo∣niacum, Bdellium, Galbanum, Opopanax, Sagapenum, a Ca∣taplasm of green Tobacco-leaves raised from Virginia-Seed, which is an admirable thing; an Amal∣gama of Saturn and Mercury, or Jupiter and Mercury, &c.

XV. Amongst Compounds, there are Forestus his Cerate of Ammo∣niacum, Mynsicht his Emplastrum de Galbano crocatum, Vigo his Emplastr. de Ranis with a four∣fold quantity of Mercury, a Plate of Lead besmeared with Quicksilver, Ʋng. Nicotianae, Cosmeticum, ad Scabiem & Mercuriale, Empl. ad Strumam, & Mercuriale, with many others of like kind.

XVI. To these things, add proper Baths, and often Bathing; according to the Directions which we have given in the former Chapter; which are in∣deed not only often, but for a long time to be repeated.

XVII. But if the Disease is so inveterate, as to be fixed and con∣firmed in the Part, as to be out of all hopes of Cure, you have nothing more to do, but constantly to apply palliative Remedies to the end of the Patient's life: unless he will admit of that last and absolute means, to wit, Amputation; which at once frees him from his Disease, and continued trouble together.